Surgical ambulance referrals in sub-Saharan Africa – financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia

Abstract Background An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges. Methods We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016. Results At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year. Conclusion Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case – besides equitable access to healthcare – for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.

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A geospatial analysis of two-hour surgical access to district hospitals in South Africa

10.21203/rs.3.rs-20559/v3 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan ◽

Improve Access

Abstract Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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Two-hour surgical access in South Africa: a useful indicator in a middle-income country?

10.21203/rs.3.rs-16476/v1 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Middle Income ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan

Abstract Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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Two-hour surgical access in South Africa: a useful indicator in a middle- income country?

10.21203/rs.3.rs-20559/v1 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Middle Income ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan

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A geospatial analysis of two-hour surgical access to district hospitals in South Africa

10.21203/rs.3.rs-20559/v2 ◽

2020 ◽

Author(s):

Kathryn Chu ◽

Angela J Dell ◽

Harry Moultrie ◽

Candy Day ◽

Megan Naidoo ◽

...

Keyword(s):

South Africa ◽

District Hospital ◽

Surgical Care ◽

Sub Saharan Africa ◽

Surgical Capacity ◽

Surgical Access ◽

District Hospitals ◽

Government Hospitals ◽

Sub Saharan ◽

Improve Access

Abstract Background: In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within two hours. The objective was to identify the proportion of the population living within two hours of a district hospital with surgical capacity in South Africa. Methods: All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods.Results: Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion: Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

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The burden of foster children in Nigeria : deconstructing their existential realities and the will to survive

African Journal of Development Studies (formerly AFFRIKA Journal of Politics, Economics and Society) ◽

10.31920/2634-3649/2021/v11n1a11 ◽

2021 ◽

Vol 11 (1) ◽

pp. 229-247

Author(s):

Ezebunwa E. Nwokocha ◽

Turnwait O. Michael

Keyword(s):

Coping Strategies ◽

Foster Children ◽

Rational Choice Theory ◽

Choice Theory ◽

Sampling Technique ◽

Sub Saharan Africa ◽

Negative Consequences ◽

Young Family ◽

Child Fosterage ◽

Sub Saharan

Child fosterage is one of the major manifestations of lack of capacity to cater for young family members in several societies of sub-Saharan Africa, which is reputed for prolific and sustained childbearing in the context of poverty. In Nigeria, the practice remains rife, with attendant negative consequences for foster children and communities in some cases. This paper, therefore, examined the challenges and coping strategies adopted by foster children in Bayelsa State, which was identified as one of the areas with high rates of child fosterage in Nigeria. Ethnomethodology and the rational choice theory were adopted as the theoretical framework. A total of 408 copies of a questionnaire were administered on respondents through a multistage sampling technique. Six in-depth interviews and two focus group discussions were conducted with foster children. The challenges reported by these children included physical abuse and maltreatment, lack of love and care, and lack of freedom of speech and boldness. Among the coping strategies identified by the foster children were endurance and silence, obedience and humility, and the uptake of paid jobs. There is, therefore, an urgent need for sustained fertility decline in order to discourage unnecessary child fosterage in Bayelsa and other states in Nigeria.

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The burden of urological disease in Zomba, Malawi: A needs assessment in a sub-Saharan tertiary care center

Canadian Urological Association Journal ◽

10.5489/cuaj.5837 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Tristan Juvet ◽

James R. Hayes ◽

Sarah Ferrara ◽

Duncan Goche ◽

Robert D. Macmillan ◽

...

Keyword(s):

Urinary Retention ◽

Urethral Stricture ◽

Care Center ◽

Tertiary Care ◽

Surgical Care ◽

Sub Saharan Africa ◽

Care Hospital ◽

General Anesthetic ◽

Urethral Stricture Disease ◽

Sub Saharan

Introduction: A large part of the developing world continues to lack access to surgical care. Urology remains one of the least represented surgical subspecialties in global health. To begin understanding the burden of urological illness in sub-Saharan Africa, we sought to characterize all patients presenting to a tertiary care hospital in Malawi with a urological diagnosis or related complaint in the past year. Methods: Retrospective review of the surgical clinic and surgical theater record books at Zomba Central Hospital (ZCH) was performed over a one-year time span. Patients presenting with urological diagnoses or undergoing a urological procedure under local or general anesthetic in the operating theater were identified and entered into a database. Results: A total of 440 clinical patients were reviewed. The most common clinical presentations were for urinary retention (34.7%) and lower urinary tract symptoms (15.5%); 182 surgical cases were reviewed. The most common diagnoses for surgical patients were urethral stricture disease (22%), bladder masses (17%), and benign prostatic hyperplasia (BPH) symptoms (14.8%). Urethral stricture-related procedures, including direct visual internal urethrotomy and urethral dilatation were the most common (14.2% and 7.7%). BPH-related procedures, including simple prostatectomy and transurethral resection of the prostate were the second most common (6.7% and 8.2%). Conclusions: Urethral stricture disease, BPH, and urinary retention represent the clinical diagnoses with the highest burden of visits. Despite these numbers, few definitive procedures are performed annually. Further focus on urological training in sub-Saharan Africa should focus on these conditions and their surgical management.

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Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa

African Health Sciences ◽

10.4314/ahs.v19i3.32 ◽

2019 ◽

Vol 19 (3) ◽

pp. 2565-2570

Author(s):

Claude Kasereka Masumbuko ◽

Edward Gakuya Mutheke ◽

Benjamin Mbindyo ◽

Michael T Hawkes

Keyword(s):

Surgical Care ◽

Elbow Flexion ◽

Operative Management ◽

Humeral Fractures ◽

Sub Saharan Africa ◽

Delayed Surgery ◽

Flexion Extension ◽

Supracondylar Humeral Fractures ◽

Sub Saharan

Background: Supracondylar humeral fractures (SHFs) in children are associated with morbidity due to elbow stiffness. Timely operative management and/or physiotherapy are thought to reduce this complication, but pose challenges in settings with limited resources for health.Methods: This prospective cohort study included 45 pediatric patients with isolated SHF at a large tertiary hospital in Nairobi, Kenya. Patients were managed non-operatively or operatively with varying wait times to surgery, with or without physiotherapy. The measurement of elbow ROM was done up to 12 weeks after removal of Kirshner wires and/or backslab.Results: Elbow ROM increased in the follow-up period, yet residual restricted mobility in the flexion-extension plane was common. Delayed surgical management ≥7days was associated with reduced elbow ROM in the flexion-extension plane at 12 weeks median IQR 105° 92°-118° vs 120° 108°-124°, p=0.029. Physiotherapy was associated with reduced ROM at 12 weeks p=0.003, possibly due to the use of prolonged immobilization.Conclusion: In this study of pediatric SHFs at a resource-limited hospital, elbow flexion was restricted at 12 weeks follow-up and was associated with major delays in operative management. Quality of orthopedic surgical care and physiotherapy services in low-resource settings deserves further attention.Keywords: Delayed surgery, reduced elbow range, supracondylar humeral fractures, sub-Saharan Africa.

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Users’ Perception of Financial Reporting Quality in Ghana

Accounting and Finance Research ◽

10.5430/afr.v8n3p187 ◽

2019 ◽

Vol 8 (3) ◽

pp. 187

Author(s):

Joseph Mbawuni

Keyword(s):

Financial Reporting ◽

Middle Management ◽

Reporting Quality ◽

Middle Level ◽

Sub Saharan Africa ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Financial Reports ◽

Sub Saharan ◽

Five Dimension

This paper assesses the extent to which top and middle management perceive FRQ of companies in Ghana after the adoption of International Financial Reporting Standards (IFRS). Drawing from the literature, a five-dimension FRQ questionnaire was developed for the study. It was a cross-sectional survey that involved a sample of 500 respondents from top and middle level management across seven industries in Ghana. The findings indicate that, generally top and middle management perceive the qualitative characteristics of FRQ of the Ghanaian companies to be very good. However, Timeliness of FRQ in terms of publishing audited financial reports was the only poorly rated qualitative characteristic. Implications to accounting theory and practitioners are discussed. Moreover, there were differences in respondents’ perception of FRQ according to their work background characteristics. It was found that top and middle management who were professional accountants were more critical in their assessment and therefore rated their perceived FRQ significantly lower than those who were non-accounting professionals. This study contributes to filling the void in FRQ literature regarding accounting information users’ assessment of FRQ in IFRS-compliant countries in Sub-Saharan Africa.

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